Tiffany Gilyard
Lawrenceville,GA
Summary
Dynamic Client Support and Claims Specialist with 10+ years of experience delivering high-quality service within healthcare and insurance environments. Known for exceptional problem-solving, strong analytical skills, and the ability to manage complex cases with accuracy and efficiency. Adept at navigating regulatory guidelines, resolving escalated issues, and supporting cross-functional teams to meet organizational goals. Thrives in fast-paced settings and excels at building trust with clients, providers, and stakeholders.
Overview
7
7
years of professional experience
1
1
Certification
Work History
Claims Processor
Elevance Health
01.2024 - Current
- Review and process insurance claims ensuring accuracy, policy compliance, and regulatory adherence.
- Conduct detailed research on claim discrepancies to determine proper resolution pathways.
- Address complex billing inquiries and process premium payments while maintaining strict confidentiality.
- Provide claim status updates to clients and internal partners, ensuring smooth communication and transparency.
- Document all interactions and maintain meticulous records to support audit readiness.
- Facilitate referrals and authorization requests while meeting departmental quality and productivity benchmarks.
Claims Support Specialist
Kaiser Permanente
01.2021 - 01.2024
- Managed high-volume claims across multiple lines of business, ensuring alignment with CMS guidelines.
- Utilized claims systems to input data, generate reports, and track claim progress.
- Investigated coverage disputes, denials, and potential fraud, resolving issues efficiently.
- Collaborated with internal teams, vendors, and providers to accelerate claim resolution.
- Delivered exceptional service by assisting members with claim-related questions and concerns.
- Performed payment variance research and executed corrective actions to maximize timely reimbursement.
Referral Specialist
Centene
01.2019 - 01.2020
- Processed referrals for specialty and ancillary care, prioritizing requests according to urgency and clinical need.
- Coordinated appointments and ensured accurate, timely communication with members and providers.
- Verified eligibility, benefits, and required authorizations for Medicare and Medicaid patients.
- Maintained continuity of care by tracking referral statuses and securing consultation reports.
- Consistently exceeded monthly productivity and accuracy targets.
- Strengthened provider relationships through accurate diagnosis and procedural entry.
Education
Health Science (Nursing) — Major, Business Management — Minor
Gwinnett Technical College
01.2018
Medical Billing & Coding Specialist - Certificate
Laurus Technical Institute
01.2012
Skills
- Claims Processing & Compliance (CMS, Medicare, Medicaid)
- Customer Support & Issue Resolution
- Data Analysis & Documentation
- Medical Billing & Coding
- Referral & Authorization Management
- Investigations & Discrepancy Resolution
- Time Management & Multitasking
- Microsoft Office Suite Epic Adobe Acrobat
- Claims review
- Accuracy and precision
Accomplishments
- Received recognition award for completing the most aged UM reviews, improving patient access to care.
- Regularly commended for accuracy, professionalism, and customer-focused service.
Certification
- Certified Billing and Coding Specialist (CBCS)
- CE: Medical Billing & Coding Completion
Timeline
Claims Processor
Elevance Health
01.2024 - Current
Claims Support Specialist
Kaiser Permanente
01.2021 - 01.2024
Referral Specialist
Centene
01.2019 - 01.2020
Medical Billing & Coding Specialist - Certificate
Laurus Technical Institute
Health Science (Nursing) — Major, Business Management — Minor
Gwinnett Technical College